The COVID-19 pandemic significantly accelerated the adoption of virtual care across the spectrum of healthcare, including treatment for behavioral health issues such as eating disorders. While virtual care has provided a vital connection to treatment and become an accessible option for referring providers and patients, virtual care is only one component in a comprehensive approach to adequately meet the complex, long-term needs of all individuals with eating disorders. Effective treatment requires a wide range of care options, including virtual and in-person options, delivered across a continuum of outpatient, intensive outpatient, day treatment, residential, and inpatient treatment, to address the unique needs of each patient.
The Limitations of Applying One Approach to Care for All People with Eating Disorders
Some treatment providers claim that online outpatient-only eating disorder treatment can meet the needs of people who would typically receive treatment in higher levels of care. Although this can be true in certain cases, suggesting that virtual care is sufficient for all or most persons with an eating disorder is an overstatement with life-threatening consequences to patients in need of more intensive treatments and direct medical oversight.
Research consistently shows that eating disorders are among the most complex behavioral health conditions to treat due to their multifactorial nature, involving a complex interaction of genetic, biological, behavioral, psychological, and social factors. High-quality eating disorder care requires a comprehensive treatment approach based on client need, clinical expertise, and best-practice care that leverages virtual and in-person treatment as clinically indicated, delivered in the appropriate level and environment of care. A full and comprehensive assessment conducted by a qualified professional will indicate whether virtual or in-person treatment is best for the patient and in what kind of care setting, which may include outpatient, intensive outpatient, day treatment, residential, and inpatient treatment options as appropriate.
While virtual care delivery can be sufficient, convenient, and effective treatment for some individuals, relying solely on online outpatient care for all people with eating disorders oversimplifies the reality of these disorders. According to the National Institute of Mental Health, many people with eating disorders are at higher risk for suicide and medical complications and often suffer from other mental disorders, such as depression or anxiety, or problems with substance use, and require more intensive and integrated care than online treatment alone can provide. In fact, nearly 20 percent of The Emily Program’s patients require round-the-clock care for life-threatening symptoms, which virtual care alone may not address.
For instance, patients with severe eating disorders frequently experience medical symptoms and conditions that require direct monitoring from a qualified medical professional that can only be delivered in a residential or intensive in-person day treatment. Additionally, it is not uncommon for patients with eating disorders to present with low motivation and resistance to treatment and behavior change. The structure of this kind of intensive treatment provides greater accountability and support. Within a program with a comprehensive continuum of care, the flexibility to move between higher or lower levels of care ensures continuity, minimizes disruptions that could hinder recovery, and supports long-term success. This kind of comprehensive approach spanning the full array of best practice care provides integrated, continuous treatment options that keep patients engaged in recovery. It also provides a bedrock of strong relationships with their treatment team and facilitates perhaps most impactfully, creating the recovery supporting sense of community that comes from sharing the recovery journey in a group with others.
Warning Signs That May Be Overlooked in Virtual Eating Disorder Support
Many people think they can manage eating disorders while balancing daily life, so they initially opt for outpatient-only virtual care, which can give the impression of progress but may prevent deeper recovery. They may also engage with a virtual treatment that is inadequate for their particular needs in order to satisfy a loved one’s urging them to get help. The insufficient nature of the treatment, however, may allow the eating disorder to continue to worsen or become more entrenched in the person’s life while they report being involved in care.
Warning signs that can be overlooked in virtual care include subtle physical changes like weight fluctuations; changes in skin health or physical weakness; changes in social behavior, like isolation or decreased interaction with family and friends; self-harm; suicidal thoughts; or other challenges patients may not openly disclose.
The Right Level of Care Saves Lives
While virtual care has expanded treatment access, it is a part of the treatment continuum, not the whole answer. Ultimately, there can be no one-size-fits-all approach to eating disorder treatment. High-risk patients require a full continuum of care with the flexibility to shift between virtual and in-person care as their needs demand. Patients and payers alike should proceed with caution as they choose a provider of eating disorder care. Providers with comprehensive care with virtual and in-person services, including a truly full continuum of care, present patients, referring providers, and payers with the strongest potential for long-term recovery.
Tom Britton
Dr. Tom Britton is CEO of Accanto Health, parent company of The Emily Program.
